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Indian Pediatr 2010;47: 986 |
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Gaurav Gupta
Email:
[email protected]
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Cost-effectiveness of epinephrine and dexamethasone in
children with bronchiolitis. (Pediatrics 2010; 126 (4): 623-31) |
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Using data from the Canadian Bronchiolitis Epinephrine Steroid Trial this
study assessed the cost-effectiveness of treatments with epinephrine and
dexamethasone for infants between 6 weeks and 12 months of age with
bronchiolitis. An economic evaluation was conducted from both the societal
and health care system perspectives including all costs during 22 days
after enrollment. The effectiveness of therapy was measured by the
duration of symptoms of feeding problems, sleeping problems, coughing, and
noisy breathing. Comparators were nebulized epinephrine plus oral
dexamethasone, nebulized epinephrine alone, oral dexamethasone alone, and
no active treatment. The combination of nebulized epinephrine plus oral
dexamethasone was dominant over the other 3 comparators in that it was
both the most effective and least costly. The average time to curtailment
of all symptoms was 12.1 days (95% CI: 11-13) for the combination therapy,
12.7 days (95% CI: 12-13) for no active treatment, 13.0 days (95% CI:
12-14) for epinephrine alone, and 12.6 days (95% CI: 12-13) for
dexamethasone alone. Treating infants with bronchiolitis with a
combination of nebulized epinephrine plus oral dexamethasone is the most
cost-effective treatment option, because it is the most effective in
controlling symptoms and is associated with the least costs.
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Surgical repair of incarcerated inguinal hernia in
children: laparoscopic or open? (European Journal of Pediatric
Surgery, Oct 2010) |
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The authors reviewed the notes of 63 consecutive children who were
admitted to a single hospital with the diagnosis of Incarcerated Inguinal
Hernia (IIH) between 2000 and 2008 [Open repair (n=35);
Laparoscopic repair (n=28)]. The study found that open repair of
incarcerated inguinal hernia is associated with serious complications. The
laparoscopic technique appears safe, avoids the difficult dissection of an
edematous sac in the groin, allows inspection of the reduced hernia
content and permits the repair of a contralateral patent processus
vaginalis if present.
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Fetal growth retardation linked to
febrile Seizures. (Pediatrics. Published online September 20, 2010) |
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The study sample consisted of participants enrolled from early fetal life
in a population-based, prospective, cohort study. Ultrasonography during
the second and third trimesters allowed determination of fetal growth
characteristics including femur length, abdominal circumference, estimated
fetal weight, head circumference, biparietal diameter, and transverse
cerebellar diameter (TCD). When participants were 12 and 24 months old,
questionnaires were administered regarding occurrence of febrile seizures.
Data were available and were analyzed for 3372 participants. The risk for
the development of febrile seizures was maximum for children in the lowest
tertile of estimated fetal weight.
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Clarithromycin for the treatment of
suboptimally controlled asthma. (J Allergy Clin Immunol
2010; 126 (4): 747-53) |
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PCR studies have demonstrated evidence of Mycoplasma pneumoniae and
Chlamydophila pneumoniae in the lower airways of patients with
asthma. 92 Adults with an Asthma Control Questionnaire score
³1.5 after a 4-week
period of treatment with fluticasone propionate were entered into a PCR-stratified
randomized, controlled trial to evaluate the effect of 16 weeks of either
clarithromycin or placebo, added to fluticasone, on asthma control in
individuals with or without lower airway PCR evidence of M pneumoniae
or C pneumoniae. Clarithromycin did not improve lung function or
airway inflammation but did improve air-way hyperresponsiveness. To
conclude, adding clarithromycin did not further improve asthma control.
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